{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:18:58Z","timestamp":1788175138033,"version":"build-2803163510"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T00:00:00Z","timestamp":1681948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Discharge against medical advice (DAMA) is an unexpected event for patients and healthcare personnel. The study aimed to assess the prevalence of DAMA in neonates along with characteristics of neonates who got DAMA and, causes and predictors of DAMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>This case-control study was carried out in Special Care Newborn Unit (SCANU) at Chittagong Medical College Hospital from July 2017 to December 2017. Clinical and demographic characteristics of neonates with DAMA were compared with that of discharged neonates. The causes of DAMA were identified by a semi-structured questionnaire. Predictors of DAMA were determined using a logistic regression model with a 95% confidence interval. A total of 6167 neonates were admitted and 1588 got DAMA. Most of the DAMA neonates were male (61.3%), term (74.7%), outborn (69.8%), delivered vaginally (65.7%), and had standard weight at admission (54.3%). A significant relationship (p &lt; 0.001) was found between the variables of residence, place of delivery, mode of delivery, gestational age, weight at admission, and day and time of outcome with the type of discharge. False perceptions of wellbeing (28.7%), inadequate facilities for mothers (14.5%), and financial problems (14.1%) were the prevalent causes behind DAMA. Predictors of DAMA were preterm gestation (AOR 1.3, 95% CI 1.07\u20131.7, p = 0.013), vaginal delivery (AOR 1.56, 95% CI 1.31\u20131.86, p &lt; 0.001), timing of outcome after office hours (AOR 477.15, 95% CI 236\u2013964.6, p &lt; 0.001), and weekends (AOR 2.55, 95% CI 2.06\u20133.17, p &lt; 0.001). Neonates suffering from sepsis (AOR 1.4, 95% CI 1.1\u20131.7, p&lt; 0.001), Respiratory Distress Syndrome (AOR 3.1, 95% CI 1.9\u20135.2, p&lt; 0.001), prematurity without other complications (AOR 2.1, 95% CI 1.45\u20133.1, p &lt; 0.001) or who were referred from north-western districts (AOR 1.48, 95% CI 1.13\u20131.95, p = 0.004) had higher odds for DAMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Identification of predictors and reasons behind DAMA may provide opportunities to improve the hospital environment and service related issues so that such vulnerable neonates can complete their treatment. We should ensure better communication with parents, provide provision for mothers\u2019 corner, especially for outborn neonates, maintain a standard ratio of neonates and healthcare providers, and adopt specific DAMA policy by the hospital authority.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284705","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T17:27:02Z","timestamp":1682011622000},"page":"e0284705","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-5963","authenticated-orcid":true,"given":"Syeda Humaida","family":"Hasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagadish Chandra","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamrun","family":"Nahar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Jabed Bin Amin","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamanna","family":"Zahur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Abu","family":"Faisal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zabeen","family":"Choudhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhiman","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,20]]},"reference":[{"key":"pone.0284705.ref001","doi-asserted-by":"crossref","first-page":"307","DOI":"10.2147\/PHMT.S268100","article-title":"Discharge Against Medical Advice from NICU in a Tertiary Hospital of Central Nepal: A Descriptive Cross-Sectional Study","volume":"11","author":"RP Pokhrel","year":"2020","journal-title":"PHMT"},{"key":"pone.0284705.ref002","doi-asserted-by":"crossref","first-page":"576270","DOI":"10.3389\/fped.2020.576270","article-title":"Risk Factors and Reasons for Discharge Against Medical Advice for Newborns With Neonatal Surgical Diseases: A Preliminary Study From a Tertiary Care Hospital in Beijing, China","volume":"8","author":"S Yang","year":"2020","journal-title":"Front Pediatr"},{"issue":"2","key":"pone.0284705.ref003","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/1118-8561.215035","article-title":"Neonatal discharge against medical advice: Experience from a rural tertiary hospital in North Western Nigeria","volume":"20","author":"U. Abdullahi","year":"2017","journal-title":"Sahel Med J"},{"issue":"5","key":"pone.0284705.ref004","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/jhm.362","article-title":"Discharge against medical advice: Ethical considerations and professional obligations","volume":"3","author":"JT Berger","year":"2008","journal-title":"Journal of Hospital Medicine"},{"key":"pone.0284705.ref005","unstructured":"Discharge Against Medical Advice: A One Year Retrospective Study in District General Hospital. 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